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Quiz 2 Flashcards Preview

What are the two minor affective disorders (which are mood disorders)?

1. Depression-dysthymia (-Dysthymia is minor depression, DSM5 qualification requires: longer than two years, lowered mood/anhedonia, incidence is about 6% at any one time females are more likely)
2. Cyclothymia (-Cycles of dysthymia to minor state of mania-minor bipolar-longer than two years-no gender bias
-No drugs for these usually, some of our most brilliant people like Einstein entered this manic part of cyclothymia and was productive

2

How does marijuana cause dopamine release?

It activates cannabinoid receptors

3

What are the three different types of pain that will factor in to which analgesic we choose?

1. Musculoskeletal
2. Inflammatory
3. Visceral Pain

4

What is the pathway of pain transmission starting at the injury?

Starts at injury, the noxious stimuli activate the sensitive peripheral ending of the primary afferent nociceptor by the process of transduction. The message is then transmitted over the peripheral nerve to the spinal cord, projection neurons send axons across the midline, where it synapses with cells of origin of the major ascending pain pathway, the spinothalamic tract. The message is relayed in the thalamus to the somatosensory cortex 1 and 2.

If you are older than 85, what percent chance do you have of getting Parkinson's?

50%

7

How does administration of local anesthetic change with Parkinson's Disease patients?

For patients receiving levodopa and/or entacapone, limit administration to three cartridges of 2 percent lido with 1:100,000 epi per 30 minute period to avoid hypertension and tachycardia. For patients on selegiline, do not administer agents containing epinephrine because of result of severe hypertension.

8

How does caffeine cause dopamine release?

It activates adenosine receptors

9

What are the four basic physiologic processes in nociception? And where do they take place?

Transduction, transmission, modulation, and perception. Transduction happens in primary afferent nociceptor, then transmission happens when action potential passes through dorsal root ganglia to actual spinal cord, where modulation takes place, crosses the midline, and goes up spinothalamic tract to the thalamus, and then into the cortex where pain perception takes place.

10

What are the characteristics of Stage I of Parkinson's Disease?

Mild/Early Disease - Only one side of the body is affected, so tremor in just one limb for example, and usually with minimal or no functional impairment

11

What is the definition of nociception?

The physiological process by which information on actual/potential tissue damage is conveyed to the CNS

12

What do most abused substances do to the brain?

They enhance dopamine activity in the nucleus accumbens (particularly reltaed to pleasure, motor, and cognitive function). Glutamate and GABA are other pathways also involved.

13

What is the "gate control" theory of pain? What fibers converge for this?

The gate control theory of pain asserts that non-painful input closes the "gates" to painful input, which prevents pain sensation from traveling to the central nervous system. Therefore, stimulation by non-noxious input is able to suppress pain. So an example is putting pressure on palate to attempt to inhibit nociception from the injection. Gate control is inhibition of pain by touch. There is a convergence of inputs from A-beta and A-delta fibers, competing for same train tracks.

14

What is a severe acute anxiety-panic attack?

It is a dramatic acute outburst, peak in 10 minutes-Self-limiting-Autonomic outburst-Sense of dread and impending doom, confusion-Sometimes associated with depression

15

What are the drugs that might help with autism psychotic, aggressive or repetitive behaviors, but don't help with the progression of the disease?

Atypical antipsychotics or SSRI's

16

How does secondary activation of nociceptor nerves work?

Chemical messengers released from activated nociceptor nerve endings act locally to release messengers that further activate the nociceptors. This is positive feedback. Action potentials propagate toward the cell body in the dorsal root ganglia and then enter the spinal cord.

17

What are the four "other" opioid narcotics?

1. Meperidine (for moderate pain, demerol)
2. Pentazocine (It is unique because of its interaction with the kappa receptor, so makes it less likely that people will abuse this, it has a mixed agonist/antagonist effect)
3. Methadone (If an opioid addict is going to methadone clinics, then chart that and know that you don’t need to give them more pain coverage, also used to treat opioid addiction)
4. Buprenorphine (As they go to higher doses it turns into an antagonist, shuts everything off, and kicks them into withdrawals, so harder to get addicted to, similar to two above)

18

What are the two "other" schizophrenia types?

1. Acute psychotic disorder (-Stress-related/maybe delusions, and maybe halucinations. There is a fast recovery, and once you can resolve the stress, the psychosis goes away)
2. Schizoaffective (-Poorly defined, You have severe depression and bouts of schizophrenia, Looks a lot like bipolar)

19

What is the definition of nociceptive pain?

Pain resulting from activation of nociceptors as a result of actual or potential tissue damage and processing by the CNS (Somatic/visceral/inflammatory)

Ketoprofen and Naproxen. Ketoprofen is same properties, but more potent; 50 mg is recommended analgesic dose. Naproxen is longer-lasting and slower-acting (Aleve)

26

What kind of effects do drugs that enhance the action of NE and 5HT in the CNS have?

Antinociceptive effects. They don't give you much of a sensation other than the pain goes away.

27

What is the definition of nociceptors?

Specialized ion channels on sensory nerve endings that respond to noxious stimuli. There are 4 or 5 different nociceptors that we will be talking about

28

What are the main genetic components of Alzheimer's?

Certain apolipoprotein that has relevance, as well as abnormal APP (amyloid precursor protein) to beta amyloid

29

How is Multiple Sclerosis best diagnosed?

There are no definitive tests but MRI's are used often to get a way to feel good about diagnosis.
-MRI measures blood perfusion, and these white spots show that there is tissue damage, inflammation, cell death, and could indicate MS, you need 2 or more of these lesions to have a definitive diagnosis that it is multiple sclerosis
-These white areas could also be a tumor, stroke scar, cancer
-And you combine all this with increased symptoms

30

What is the background to, and the different types of Anxiety disorders?

It is a natural response but in excess. Involves adrenaline and the sympathetic nervous system
1. Chronic, mild anxiety - -Constant frequent times of irritation, you don’t have patience, you can’t focus
-Linked to environment, there is a cause, you can say this happened and then I got anxiety. Usually don't need drugs, just relax, take a trip
2. Chronic, moderately severe --Anxiety feelings persist for longer than 6 months, and while they may be coming and going, it is there, and it is genetic, and there is no obvious stressor. Anxiolytics, sedatives, psychotherapy, relaxation, exercise.

31

Why would combining an opioid agonist (something that mimics enkephalin) with a substance P antagonist?

You would get synergism and additivity, and it would enhance the drug, and you wouldn't have to use as much opioid agonist so you could reduce the side effects caused by opioids.

32

How many hours of CE credit on drug abuse issues in Utah do you have to take a year if you want to maintain your license?

2 hours of CE credit

33

What is the definition of drug misuse?

Either not prescribed or clinically inappropriate

34

What is the DSM-5 criteria for schizophrenia?

-They need to persist for longer than 6 months
-You have deteriorating functions, can’t take care of family or self
-Active psychosis, not relating to reality
-A differential diagnosis is that there are no drugs or trauma

35

What is the function of serotonin in the brain and what is its pathway?

Mood, memory processing, sleep cognition, and it starts in the dorsal raphe in the brainstem and gets dropped off in the nucleus accumbens, frontal cortex, hippocampus, and striatum, just like the dopamine pathway.

36

What happens when prostaglandin receptors are stimulated?

It results in activation of specific Na+ channels, making the nociceptive nerve ending more excitable, so it is increasing pain sensitization of nociceptors. If you block PG’s or don’t let them form, it doesn’t end up letting sodium come in, which doesn’t activate the TRPV1 nociceptor, and we don’t feel as much pain.

37

What are the four different subtypes of specific ion channels on free nerve endings that respond to actual or potential tissue damage?

1. Mechanical
2. Chemical
3. Thermal
4. Polymodal

38

What are the five main clinical manifestations of Parkinson's Disease?

1. Tremor/rigidity/bradykinesia
2. Postural abnormalities (-Stooped, they shuffle feet)
3. Autonomic and neuroendocrine (-Increased salivation, can give an anticholinergic like Atropine to help
-Speech is slurred as it progresses, they get frustrated
-Dysphagia - they can’t swallow very well
-They also get altered taste, and that can be an early indication that Parkinson’s is starting)
4. Late symptoms (-Depression, about 60-70% of patients get significant depression, new studies are showing that depression throughout life can make you 4X more likely to get Parkinson’s. ADHD is also linked and Ritalin)
5. Oral status (-They usually come in with a lot of root canals because it is hard for them to take care of their mouths-They salivate more but the saliva isn’t normal, it is very thick and ropy and doesn’t clean and they get cervical caries)

39

For initiation of treatment on PD patients, how long after PD meds should treatment start?

Should begin 90 minutes after PD meds, and appointments should be shorter than 45 minutes.

40

All drugs of addiction increase release of dopamine where in the brain?

The Nucleus Accumbens

41

What are the symptoms of schizophrenia?

-There are many types
-There are remissions
-They will do better than have a relapse, it is a cycle
-They have withdrawn
-Their thinking and speech is abnormal
-Usually anhedonic, they don’t get pleasure out of life, not rewarding
-Often thinking about and occasionally implement suicide
-Personal appearance is abnormal
-Tends to be worse in men
-For men, late teen to 20’s, more aggressive and faster in mens
-For women, late 20s to 30s
-Their thinking has loose connections
-They are dillusional (your sensory input is ok, but the way you interpret that input doesn’t relate to reality)
-They have hallucinations (sensory input has been corrupted)
-Emotions - flat affect
-Difficulty in filtering sensory input, get distracted easy
-Lack of pre-pulse inhibition (they get a heightened startle reflex and their brain cannot tone it down)

42

What are the characteristics of Stage V of Parkinson's Disease?

Severe, fully developed disease is present; the person often is cachectic, restricted to bed or wheelchair unless aided

43

Which drug causes the highest activity of dopamine release in the nucleus accumbens?

Amphetamines, by far, so it causes the greatest amount of neurotixicity. 1000 for meth and 350 for cocaine.

44

How do opioid narcotics cause dopamine release?

They activate opioid receptors

45

What should you avoid if you have kidney disease?

COX-1 and COX-2 inhibitors

46

Benztropine

Used for Parkinson's Disease. This is an anticholinergic medication that helps with tremors, and is effective because it counteracts the cholinergic sensitivity that arises in response to dopamine depletion. It helps dry sialorrhea from PD patients as well. It can give you confusion, blurred vision, urinary retention.

47

What is the definition of drug use?

Prescribed and clinically appropriate

48

What are the main two types of Bipolar?

1. Cyclothymia (minor bipolar, not treated with meds)
2. Major Manic/Depressive (-When they are manic, they have episodes of grandiosity that might not be realistic
-During manic episodes they can’t sleep, they are unrealistic, divorce is common-They get lost for days
-They look schizophrenic)

They release dopamine from vesicles and then they pump them in reverse out of the dopamine transporter so they can be in the synaptic cleft and activate dopamine receptors.

62

What is the nucleus accumbens?

It is a region in the basal forebrain rostral to the preoptic area of the hypothalamus. Each cerebral hemisphere has its own nucleus accumbens. The nucleus accumbens, being one part of the reward system, plays an important role in processing rewarding stimuli, reinforcing stimuli (e.g., food and water), and those which are both rewarding and reinforcing (addictive drugs, sex, and exercise). The nucleus accumbens is selectively activated during the perception of pleasant, emotionally arousing pictures and during mental imagery of pleasant, emotional scenes.

63

What is the name of the plexus of nerves in the pulp called? And what two groups of fibers does it consist of?

The Plexus of Raschkow, or Sub-Odontoblastic Plexus. It consists of sensory afferents of the trigeminal nerve and sympathetic branches from the superior cervical ganglion.

64

What is Celebrex?

It is a COX-2 inhibitor

65

What are the characteristics of dynorphins?

Act on Kappa receptors. 17 amino acids long. There are A and B Dynorphins, they are inhibitory, they tend to block a lot of the typical reward functions. The kappa receptors are antagonistic to mew and delta, but they still have analgesic properties.

66

What are the dose requirements and characteristics of Ibuprofen-type NSAIDs?

If you are above 85, what is the percentage of you getting Alzheimer's?

40-50% chance

70

What does amphetamines do th dendrites and synaptic connections?

They alter dendrites and increase synaptic connections and the influence of an axon is dependent on how many connections are made from one cell to another so Meth makes reward become a more potent driver with these increased synaptic connections.

71

What is the main Butyrophenone drug?

Haloperidol

72

What are the two "hypnotic" benzodiazepine drugs used to treat anxiety disorder?

What is the name of the nucleus that inputs the information to the thalamus?

Trigeminal nucleus

74

What are the three main anti-epileptic drugs used for Bipolar Disorder?

1. Valproic Acid
2. Carbamazepine
3. Lamotrigene

75

What are the main three therapeutic uses for opioid narcotics?

1. Analgesia (somatic and visceral)
2. Antitussive
3. Antidiarrheal

76

L-dopa + Carbidopa

Used for Parkinson's Disease. L-dopa gets across blood-brain barrier much better than dopamine, and Carbidopa blocks the metabolism of L-dopa and dopamine so it can last longer. Some drugs are used in combination with carbidopa-levodopa to either inhibit dopamine breakdown by the body or to improve the effectiveness of carbidopa-levodopa. Azilect inhibits dopamine breakdown while Entacapone improves the effect of Carbidopa-levodopa by inhibiting COMT, Catecholamine Methyl Transferase, which metabolizes neurotransmitters like MAO does.

77

Which part of the brain integrates CNS information to make complex decisions and select appropriate behaviors, GO-NO Go system?

-Free radicals are usually not good things and the body like to keep these things controlled.
-They are reactive electrons that cause a cascade of protein damage and interfere with gene expression
-The two places most likely to do this are the catecholamines, especially dopamine, and the other source of free radicals is glutamate, which generates nitric oxide
-e.g., catecholamines [quinones] and glutamate [NO

-Proteins by nature are very sticky because of negative and positive charged sides.
-They are also abnormally sticky because of a protein alteration because of genetics, trauma.
-These can elicit an inflammatory response, which can then compromise function, and this is all associated with Beta-amyloid (which is known with Alzheimers)

80

Which part of the brain is involved with being the impulsivity center, rapidly selects behaviors based on dominance, rewards, and pereceived immediate emotional needs?

Amygdala/nucleus accumbens.

81

What is the definition of neuropathic pain?

Pain sensations that may be continuous or periodic, but occur without activation of nociceptors by actual or potential tissue damage. Hyperalgesia and allodynia are common and dramatic here. May result form abnormal activity in nociceptive fibers that have been damaged, but after injury has healed, or from abnormal activity in central pain pathways. There is no protective function and it does not terminate with healing. Triggers can initiate. Involves continuous deep burning, aching, or periodic shock, and is characterized by 1 or more peripheral nerves caused by damage to the nerve.

82

What is the most potent opioid narcotic and what is it's equipotent IM dose?

Fentanyl at 0.1 mg

83

What are the characteristics of Monoamine Oxidase Inhibitors?

They block the metabolizing enzyme for monoamines (serotonin, dopamine, epinephrine, NE), so they increase these neurotransmitters. Side effects include altered autonomic system activity, orthostatic hypertension, weight gain, may interact with foods that have tyra mine, people have died from eating these foods and taking an MAOI inhibitor, remember these will enhance the nervous system, so when we provide local anesthetic with epinephrine, it could cause cardiovascular problems

84

Is the D1 or D2 receptor more involved with pleasure?

-D2 receptor is more involved with the pleasure than D1, and if you activate these too much, it could start to look like Schizophrenia (to treat Schizophrenia you use a D2 antagonist)

85

What is the group of people must susceptible to multiple sclerosis? More males or females?

Scandinavians have a high incidence, Japan has low. 2:1 ratio from male to female.

What are the three main classes of opioid receptors and what are the three endogenous opioid peptides that interact with them?

Mu, Delta, and Kappa. Enkephalin, Beta-Endorphin, and Dynorphin.

90

What are the characteristics of Anti-epileptic agents for treating Bipolar Disorder?

These have fewer side effects, better compliance, more expensive, usually for maintenance after lithium starts, GABA/Glutamate pathways might be responsible for some of the bipolar cycling, depression and manic staging, and that is why antiepileptic agents work.

91

What is central sensitization?

It is when dorsal horn projection neurons become sensitized and hyper-responsive to nociceptive input, which contributes to hyperalgesia, and to touch input, which contributes to allodynia. Prostaglandins released from neurons and/or glia in the dorsal horn in response to neural input and inflammatory mediators are probably involved in central sensitization as well. And NSAIDS can inhibit the synthesis of prostaglandins in the dorsal horn that participate in central sensitization, this is considered a second mechanism for the anti-nociceptive action of NSAIDS.

92

What are the characteristics of Stage III of Parkinson's Disease?

Moderate Disease - Both sides of the body are affected, and there is mild imbalance when standing or walking; however, the person remains independent

93

What is acetaminophen's mechanism?

It is a Non-NSAID, Non-COX 1 or 2 inhibitor—perhaps blocks a COX 3 and/or works on 5HT. It is non-anti-inflammatory, has good anti-pyretic and some good analgesia. So does not help with inflammation, but can help with pain caused by inflammation.

94

In regards to the MSE, what is cognitive function, and what are the means of assessing?

It is information processes, decision-making, planning and implementing.
The assessment takes place with orientation (-Relate to environment, do you know who you are, question after concussion), concentration (-Can they focus
-Can they stay on task), memory (-Short, intermediate, long-term memory? The first one to dissapear for Alzheimer’s is short), fund of knowledge (-Do you have a wealth of knowledge, well-informed, read the newspaper), abstraction (-Going obvious to subtle
-Taking basic instruction, extrapolate to real-life case), judgment (-Appropriate reactions to situations like someone telling you your zipper is down), and insight (-Subtle-Intuitive-Schizophrenics are horrible at reading facial expressions)

95

In what two areas do opioid analgesics primarily act on?

The Periacqueductal Gray (PAG) and the Dorsal Horn.

96

How can you get analgesic effects in the dorsal horn of the spinal cord?

Any influence that reduces the release of glutamate and substance P from the primary afferent are analgesic.

97

What does Bupropion treat, and what are its characteristics?

It is used to treat anxiety disorders, and it is a non-sedating sedative, not a depressant, but still has anxiolytic activity. We use it for everyday stress and anxiety. Usually for short-term use. Not very addicting, can interact with MAO inhibitors or anti-seizure medicines.

98

What is the first-line drug treatment (3 of them, and they are all FDA approved) to manage neuropathic pain like Trigeminal neuralgia?

They enhance GABA, has short-acting for anesthesia induction, and long-term for seizures. This one is a major depressor of respiration and tolerance (careful with the airway). Not frequently used, narrow margin of safety, major interactions with liver.

100

What happens to post-synaptic D2 receptors after long-time drug addictions?

The ability to experience rewards is damage, the receptors are not as receptive or plentiful because the body is trying to get rid of them because of the increased synapses that have been taking place bcause of the drug addiction. If their D2 receptors are not receptive, they are not getting the same high from something that we might be getting high from.

101

What are the main drugs used to treat bulimia or anorexia?

Fluoxetine and other antidepressants. The compulsiveness is more involved with Bulimia than with Anorexia, at least the treatment shows more improvement with Bulimia

102

What are the three "other" NSAID agents that are all prescription only?

1. Indomethacin - potent non-selective NSAID/ due to side effects not a common analgesic
2. Meloxicam - preferentially inhibits Cox-2 over Cox-1/ means less GI problems
3. Diflunisal - Related to salicylates- supposed to be good for bone pain

103

What are the dose requirements and characteristics of Salicylates?

COX-1 and COX-2 inhibitor.
Analgesia is 600 mg
Anti-inflammation is 1 gm
Antipyretic is 300-600 mg
Duration is 4h
-Causes GI irriation, anti-clotting (-You are permanently damaging the platelet when you take these, and you have to regrow platelets, and this anti-clotting can happen with less than 100 mg of salicylates. Don’t prescribe salicylates when you are doing surgery on patients. -When the acetyl group breaks off, this turns into an acid. It has direct and indirect effects on this.), ringing in ears, and Reyes Syndrome in children (With Reyes- You can have permanent damage done to the brain, that is why aspirin-containing products are forbidden in children)

104

What two compounds does COX-2 produce, and what are their three roles in the body?

They sit on the dopamine transporter so dopamine cannot be picked up back into the neuron, so they are reuptake blockers.

106

In regards to the MSE, what is thought, and its three categories?

Thought process (organization, able to organize a reasonable answer to a question, needs to be consistent and sequential
Thought content (relevant, insightful)
Thought perception (understanding, interpretation of what is happening in the environment)

How many have Huntington's Disease? How long do you live once you've been diagnosed on average? What is the name of the gene involved?

0.01%
5-10 years once diagnosed
Hunting gene, if you have it, you will get Huntington's Disease

109

What three groups of pain medications work at the Dorsal Horn (modulation sites) level?

1. Local Anesthetic
2. Opioids
3. NSAIDS

110

What are the main two clinical manifestations of Huntington's Disease?

1. Abnormal moves (These moves are eruptive, unpredicted, twisting, turning, grimmacing, facial contortions. We have excess dopamine activity going on here)
2. Progressive intellectual dysfunction (Early on with this disease, they have poor judgment, withdraw from people, get severely depressed. Later on, they become psychotic (Schiz), they get paranoid, compulsive about doing things certain ways)

111

How does alcohol and sedative/hypnotics cause dopamine release?

They activate GABA receptors; an inhibitory transmitter

112

What are the two main classes of anti-psychotic drugs?

1. Phenothiazines - Least expensive, older, more sedation and weight gain, less extrapyramidal side effects, antiemetic action. Anticholinergics mask the effects of tardive dyskinesias but the damage is still being done. Anticholinergics are also used to treat Parkinson’s Disease.
2. Butyrophenones - High extrapyramidal side effects, lacks anticholinergic action

A delta fibers are small, myelinated, fast conducting, associated with mechanical, thermal nociceptors, and they transmit "first" or "fast" pain, diameter of 1-6 mm, sharp localized pain when dentin is first exposed, and more associated with a reflex than C fibers.
C fibers are small, unmyelinated, slow conduting, associated with polymodal nociceptors, and they transmit "slow" or "second" pain, diameter of 2 mm, associated with conduction of dull, difuse pain.

115

What are the clinical manifestations, stages, and brain regions affected in Alzheimer's disease?

-Most common, anywhere from 3-4 million people have it at any given time
-Once diagnosed, 10-20 years usually they live
-It is broken down into three stages, and all of this relates to eliminating extra capacity of the brain
-The brain determines what kind of capacity it will have later on when we are children and adolescents. Brain regions involved are frontal cortex, which is intelligence, judgement, and behavior, memory in the temporal lobe, and language right behind it in the parietal lobe.
-Early stage is annoying stage, they have memory lapses and forget names, don’t like change
-Moderate stage is when they have problems functioning, normal routine is disrupted
-Late stage the motor system gets disrupted, they get less mobile, no judgment, immobile and stop eating.

116

How many million Americans use prescription drugs at least once a year for "non-medical" reasons?

9 million

117

Are COX-1 and COX-2 constitutive or induced?

COX-1 is constitutive, meaning it is always there under normal conditions in many tissues. COX-2 is induced by hormones, growth factors, and inflammatory mediators, and isn't always present.

118

What are the main treatment options for Multiple Sclerosis?

Prednisone is most common, it is a steroid used for anti-inflammation. Interferons are more extreme, as well as methyltrexate, which are both anti-cancer treatments.

119

How do we go about treating Alzheimer's? What about treating symptoms of Alzheimer's?

-We try and increase ACh activity
-We largely use Cholinesterase inhibitors
-The main drug to know is Donepezil
-Anti-inflammatories also help
-For treating symptoms of Alzheimer's, antipsychotics/antidepressants and other drugs.
-They say you can help prevent it with exercise.

120

How would a PET help with mental status examination?

It will tell us where our metabolism of a certain sugar occurred. For a depressed patients, it won’t light up in many places.

121

Besides the Mental Status Examination (MSE), what are the two other tests used?

Electroencephalogram and Brain imaging. Electroencephalograms measure the surface electrical activity of the brain. They don’t diagnose this from that but they can indicate reliable diagnostic patterns. Brain imaging involves a CT, MRI, and PET.

122

What two groups of pain medications work at the Descending Modulation level?

1. Serotonin drugs
2. Neuropeptides

123

What is SSRT and what does it mean?

It stands for stop-signal reaction time, and it relates to the ability for this pathway, the slower the connector is from the amygdala, the poorer the reaction time, and the more likely that the person will have problems controlling impulsiviity.

124

In general, does it usually take a higher dose to relieve pain or inflammation?

Inflammation

125

What three compounds is Excedrin made up of?

Aspirin, Acetaminophen, and Caffeine

126

What are phobic disorders and how do we usually treat them?

They are irrational fears, we know what the cause is unlike anxiety sometimes, but it’s not rational. Symptoms are not always precipitated (meaning all of the sudden it overcomes you, it can happen that way), and they are illogical. We treat them with SSRI's like Sertraline.

127

What is the mechanisms of drugs treating schizophrenia?

-All of them block D2 (-Both pre and post synaptic receptors, you can’t have selective D2 blockers) receptors, but also have other effects that likely contribute. (e.g., 􏰂atypical􏰄 antipsychotics also block 5HT2 (-Also an autoreceptor, and sits on dopamine neurons) receptors)-correlates with antipsychotic actions.
-A side effect is excessive D1 activity because everything else is blocked

128

What part of the brain do cognitive therapies help out with?

Frontal Cortex

129

What are the two main classes of drugs to treat Bipolar Disorder?

1. Lithium Carbonate
2. Anti-epileptic agents

130

How are opioid narcotic overdoses treated?

Inject the Mu antagonist - naloxone (Narcan). Although it may precipitate withdrawals, and it will block the endorphins (endogenous opioid systems), and if you take these alone, you will get anxiety, stress, or hypersensitivity to pain

131

Which part of the brain establishes priorities and motivation to assist Pre-frontal cortex in decision making?

Orbitofrontal cortex

132

What is the pathophysiology of Multiple Sclerosis?

It all comes down to oligodendrocytes getting damaged and the myelin is then lost, which results in abnormal or missing conduction. They believe that a virus might trigger it causing acute inflammation and an auto-immune response.

133

What are the main functions of the dopamine pathway? And where in the brain does it go?

Reward, pleasure, motor function, compulsion, perserveration, decision-making. It starts in the Substantia nigra, gets dropped off in the nucleus accumbens, the hippocampus, the striatum, and the frontal cortex.

134

What does COX-2 normally help out with?

Cardiovascular protection, renal activities, pain, fever, inflammation. The pain, fever, and inflammation are the inducible activities of COX-2, while the others are constitutive.

135

What are the histological components of Alzheimer's?

-Senile plaques (they are inside of the neuron), associated with the B-amyloid plaques
-Neurofibrillary tangles, associated with a tau protein
-Protein aggregates precipitate and cause inflammation and kills cells. Diminish capacity of brain, not able to do multiple tasks concurrently.

136

What are the characteristics of beta-endrophins?

Act on Delta and Mu receptors. 91 amino acids long. -You can’t give a Beta-endorphin therapeutically, it would be proteased too quickly, but we have drugs that have opioid agonist properties that have a number of naturally occurring narcotics that have selective activities that act on mu or delta receptors.

137

What is DOPL?

It stands for Division of Occupational and Professional Licensing. It monitors and regulates the prescriptions of drug prescribers, like Dentists. It also establishes qualifications and requires training for licensing and certifications.

138

Which COX inhibitor (1 or 2) is more associated with GI issues and bleeeding?

COX-1 inhibitors. Wouldn’t want to use Cox-1 inhibitor on a bleeding ulcer because it is an anticoagulant and causes GI problems.

139

What are the characteristics of Monoamine Uptake Blockers?

They block 5HT, NE, doppamine receptors. They have minimal withdrawal because of less or no anti-cholinergic activity, so less xerostomia, constipation, etc. There are two main kinds: Selective Serotonin Reuptake Blockers (SSRI's) and NE or Mixed transport blockers.

140

What is the mechanism behind apoptosis triggering CNS degenerative diseases?

-Programmed cell death, is part of natural development, healthy when done within certain framework, and uncontrolled cell death is bad. You have more glutamate neurons when you are young than when you are old. Once the area of our brain is developed we don’t need that stimulation anymore so a lot of glutamate goes under apoptosis.

141

What are lewy bodies?

They are abnormal aggregates of protein that develop inside nerve cells in Parkinson's disease (PD), Lewy body dementia, and some other disorders. The primary structural component of which is alpha-synuclein. These are associated with Genetics.

142

What is the name of the two anticonvulsants used for neuropathic pain?

What kind of stimulation usually takes place with nociceptors in the viscera?

Mechanical stimulation, like distention, contractions, and may even be "referred" to somatic sites (like a brain freeze)

152

What is Capsaicin used for and which nociceptor does it activate primarily?

It is used as a topical pain reliever that activates the TRPV1 directly and indirectly to make them less sensitive.

153

What does DSM-5 stand for? And what does it do?

Diagnostic and Statistics Manual of Mental Disorders. It organizes each psychiatric diagnosis into five dimensions (axes) relating to different aspects of disorder or disability.

154

What are the characteristics of Tricyclic Anti-depressants?

Have long half-life, single daily lose, they block the uptake of NE and varying affinity for 5HT transporters. They give dry mouth pretty bad, H1 blockade (H1 blockers are decongestants, used for reactions to allergies, look like traditional anti-histamine drugs, H2 blockers are used to treat GI problems, diminishing gastric secretions), some orthostatic hypertension, withdrawal with abrupt discontinuation and subsequent diarrhea because you are taking away anticholinergic effect.

155

In regards to the MSE, what is appearance?

-Relevant attire in certain situations
-Hygiene is important
-Aware of the environment
-Motivation to take things seriously and dress appropriately

156

Why is pain sensitization so important?

It is important for protection of damaged area, and because it promotes healing.

It is pain evoked by normally non-painful stimuli. On same line as hyperalgesia.

160

What is a definition of pain?

An unpleasant sensory and emotional experience associated with actual or potential tissue damage.

161

What is sensitization when it comes to pain?

It is increased sensitivity and response to stimuli in and near the injured area. It is produced by chemical messengers that do not directly activate nociceptors but which sensitize them, making them more excitable and more likely to be activated by stimuli and produce enhanced discharge frequencies.

Symptoms are highly diverse because they correspond to where the damage is happening in the brain. You can have optic, hearing, sensory, autonomic, cognition, mood, fatigue, muscle weakness and heat tends to worsen everything.

Most people entering drug treatment have additional mental health problems. What type of mental disorders are YOUTH more likely to have, in comparison with OLDER ADULTS?

Youth are more likely to have conduct disorders while older adults are more likely to be depressed or have anxiety.

169

What is MSE and how is it collected?

Mental Status Examination. The data are collected through a combination of direct and indirect means: unstructured observation while obtaining the biographical and social information, focused questions about current symptoms, and formalized psychological tests.

What is the percentage chance that someone has of inheriting genes that might affect their chance of abusing drugs?

40-60%. The process if polygenic and complex. And there might be genes that express variant receptors that are development sensitive or age sensitive, and that is why crap starts in the teens. This was shown using nicotine receptors as an example, 5X more likely if smoking began before 17 years of age, and recent studies have shown alpha 5 subunits linked to reward of nicotine.

172

What are the three components of pain?

1. Sensory-discriminative
2. Cognitive
3. Emotional/affective

173

How do you treat Huntington's Disease?

Do genetic screening. And you use a dopamine antagonist (antipsychotics), usually a D2 antagonist, and Dopamine depletion for choreiform movement, and antidepressants. The D2s are going to be on GABA, but we have lost GABA, then we don’t have a lot of it and we need whatever we can get so we shut down the inhibitory D2 so we can salvage as much GABA as we can to fight the excess dopamine.

174

What are the four subtypes of schizophrenia and their features?

1. Disorganized type -
-Blunted affect, nothing to read about facial expressions
-They are incoherent, don’t make sense
-Not particularly dellusional
-Bizarre mannerisms
2. Catatonic type -
-Nonresponsive, but aware of what is going on
-Rigid/bizarre posture
3. Paranoid type -
-Positive symptoms, so they are ofen delusional, halllucinations
-Aggressive and uncooperative
-You would actually want this type if you were a doctor giving medications because of the positive symptoms, most likely to respond
4. Residual type -
-Negative symptoms, so no delusions, socially withdrawn
-Flat affect
-Later stages is when these all get worse
-This type is most difficult to treat

175

What are the three main drugs that are Tricyclic Anti-Depressants?

1. Amytriptyline
2. Desipramine
3. Doxepin

176

What is the periacqueductal gray?

It is the primary control center for descending pain modulation. It has enkephalin-producing cells that suppress pain. The ascending pain and temperature fibers of the spinothalamic tract send information to the PAG via the spinomesencephalic tract (so-named because the fibers originate in the spine and terminate in the PAG, in the mesencephalon or midbrain).

177

What are the two main SSRI's?

1. Fluoxetine 2. Sertraline -They are popular but can give GI upset, sexual dysfunction, and depression in adolescents. They have no anti-cholinergic activity, so you don't get dry mouth.

178

What is SUD and what does it stand for?

Substance Use Disorder, it is the correct jargon for drug dependence

179

What is the "next-line" of drug treatment for neuropathic pain like Trigeminal neuralgia?

This is used for Parkinson's Disease. This is an MAO inhibitor, blocking monoamine oxidase B from metabolizing dopamine in the brain, so prolonging the effects of levodopa. Side effects include cardiac dysrhythmias.

181

What is the pathophysiology of Alzheimer's Disease?

Has a lot to do with old age and genetics. It affects the hippocampus, cortex, and nucleus basalis, and is associated with degeneration of cholinergic systems, ACh neurons.

Visceral afferent nociceptors converge on the same pain-projection neurons as the afferents from the somatic structures in which the pain is perceived, and the brain cannot distinguish the origin. An example is sinusitis and dental pain.

1. Opioid narcotics
2. Glutamate, GABA (Tramadol)
3. Antidepressants (5HT/NE) (Maybe 10% of dentists prescribe antidepressants for pain, usually when the person can’t use the common drugs like NSAIDS because of ulcers and GI side effects and stuff)

187

What do nociceptive fibers synapse with in the dorsal horn?

With "projection" neurons, because they are projecting up, and this is called modulation.

Increase in dopamine and a decrease in GABA because the cell bodies in GABA die. Patients have lost most of the cell bodies because the caudate has been lost, which sits right next to the ventricles on the outside. The hunting gene seems to alter NMDA/AMPA receptors for Glutamate, and you end up killing these receptors from over-excitation of the glutamate system. The hunting gene is found in the GABA neurons.

193

What is the main drug in treating Alzheimer's Disease and what does it do?

Donepezil, it is a cholinesterase inhibitor, targeting the cognitive and functional decline symptoms.

1. Venlafaxine 2. Duloxetine -They have no anti-cholinergic properties, so no dry mouth, unlike Tri-cyclics, have more CVS side effects due to increased NE/sympathetic activity, and are moderately a CNS stimulant (insomnia, anxiety)

197

What part of the brain do motivational enhancement therapies help out with?

The Orbital Frontal Cortex, where your saliency or your priority list is kept

198

What are the eight main mechanisms involved with CNS degenerative diseases?

It is due to the anticholinergic actions in the drugs, which are added in order to reduce excess ACh activity that is taking place because we are blocking all the dopamine, which would normally regulate the amount of ACh.
These anti-psychotics can also cause restlessness, dysrupt endocrine, and pseudodepression and some weight gain.

200

What does TRP stand for and what is it?

TRP stands for transient receptor potential. They are a group of ion channels located mostly on the plasma membrane of numerous animal cell types. They are indirect mediators of pain, making things more or less sensitive. They are involved with transduction.

201

The dorsal horn is also a major site of action for what?

The action for analgesic drugs, including opioids.

202

What is the prognosis of schizophrenia?

1. Chronic equals poor
2. Residual = poor prognosis
3. Institutionalized a lot, that is indication of severity, not a good sign
4. Life expectancy is shortened = 10% suicide, not taking care of selves
5. Best prognosis = temporary, cause-related, principally positive symptoms, If onset is later than 30 years, if person is female, and if there is no family history

203

What is the mechanism behind infections triggering CNS degenerative diseases?

-Viral/bacterial trigger immune systems
-Infections can trigger autoimmune responses
-Viruses are more common with brain infections because bacteria have a harder time getting across blood-brain barrier

204

What four groups of pain medications work at the Peripheral Nociceptor (transduction site) level?

Which COX inhibitor (1 or 2) is more associated with cardiovascular issues?

COX-2 inhibitors are more inclined to cause cardiovascular issues, because you are getting a block of vasodilation and getting vasoconstriction and have a coronary issue than you could have a stroke or myocardial infarction.

206

If you are older than 60, what percent chance do you have of getting Parkinson's?

1%

207

What is the mechanism behind hypoxia triggering CNS degenerative diseases?

-These will be cardiovascular in nature, and when you deprive the brain of oxygen you end up with strokes.

208

What are the four major opioid agonist side effects, and on which receptor do they primarily take place?

They are newer, and along with D2 antagonism, these are also good 5HT2A antagonists. They have little extrapyramidal side effects, and are most effective against the "negative" symptoms of schizophrenia.

211

What is psychosis? What is schizophrenia? And what are the demographics?

Psychosis
-They are not able to perceive what is real, they have an impaired sense of reality
-They have an altered cognition and emotion
-This is a symptom, like hypertension
Schizophrenia
-is most commonly recognized
-This is referred to as the cancer of mental illness
-This costs us about $40 billion a year in the US
-1% of people in the United States are schizophrenics
-Poor urban U.S, because that’s where they end up

212

What are the four classifications of Multiple Sclerosis?

1. Benign
2. Relapsing remission (symptoms are more severe and you are likely to be diagnosed, episodes typically don’t worsen)
3. Relapsing progressive (cycle, and symptoms worsen)
4. Chronic progression (there is no relapse, and the symptoms progressively get worse, most likely to be fatal, and represents about 10% of all types)

213

What is the biology such as the neurochemical basis and genetic elements of schizophrenia?

-No organic measure
-But there are hints, Increase in ventricular size suggests that brain damage has occurred, and because only one of the identical twins had brain damage, this says that environmental factors play a role. You get a decrease in corpus callosum, which is the pathway between the cortex, there is a decrease in frontal cortex blood (MRI), these folks don’t yawn, altered startle and accomodation
-Dopamine mechanism, D2 receptor in excess, and early anti-psychotics are D2 antagonists
-But the more we study, 5HT may also contribute as well as glutamate, especially to the negative symptoms, and dopamine is more associated with the positive symptoms.
-There is also a genetic predisposition

It suppresses its expression. You are very more likely to get Parkinson's disease with substance use disorders or addictions.

216

What are salicylates?

They are non-selective COX-1 and COX-2 inhibitors, ibuprofen-like, so they are NSAIDS.

217

Which drug is notorious to avoid for anyone with liver damage/alcohol dependencies?

Acetaminophen

218

What is the definition of somatic pain?

Pain associated with musculo-skeletal system and skin - it is well defined. We will see mostly somatic pain in the dental office.

219

Why is nociceptive pain important to feel and how is it usually terminated?

It is important in signaling actual or potential tissue damage, and is normally terminated by the healing and repair process. However, too much pain can also be maladaptive.

220

What part of the brain do contingency management therapies help out with?

The cortial-amygdala region, this is saying, if you stay drug-free, I am going to give you a reward.

221

What is the definition of neuropathic/neurogenic pain?

A pathophysiological process resulting from abnormal sensory processing, which does not signal actual or potential tissue damage, does not promote healing or repair, and may be considered a disease. Fibromyalgia is an example of neuropathic pain.

222

Entacapone

Used for Parkinson's Disease. It inhibits COMT, Catecholamine methyl transferase, which metabolizes like MAO does. So works similar to Seligiline, in the sense that they are both inhibiting metabolizing agents.

What is another name for the endogenous opioid peptides? And what do they do?

The Endorphins. They play a key role in inhibitory feedback and other physiological processes. They activate various opioid receptors, which are also receptors for opioid analgesic drugs (Mu, delta, and kappa)

234

What is the main cause for autism?

Genetics and environment. It tends to associate with certain medical conditions, like Fragile X syndrome, congenital rubella syndrome, PKU. They are also more vulnerable to toxins because they can't metabolize them as well.

235

Pramipexole

This is a dopamine agonist, a D2 agonist, which bypasses the depleted neurons int he substantia nigra and provides long-lasting direct stimulation of dopamine receptors. Side effects include orthostatic hypertension, nausea, vomiting, confusion.

236

What are the characteristics of Benzodiazepines?

They are agonists on BDZ receptors (allosteric modulators of GABA A receptors). BDZ doesn’t directly activate the GABA receptor, isn’t an agonist, but it indirectly regulates the sensitivity of the receptor so making it more or less receptive to GABA. These have little effect on respiration, most popular CNS depressants, anxiolytic, helps with alcohol withdrawal, treats insomnia (is short-acting, so they don't sleep the whole day). Tolerance is common with long-term use, interacts synergistically with other depressants, drowsiness, motor impairment, kids can have paradoxical reaction, don't use with people with intellectual disability to avoid suicide.

237

What is SBIRT?

It stands for Screening, Brief interview, Intervention, Referral, &amp; Treatment. It is how we assess and monitor drug prescriptions and abuse.

238

What are some disorders found in Axis III?

Brain injuries and other medical/physical disorders which may aggravate existing diseases or present symptoms similar to other disorders, (sometimes drug
￼￼￼￼￼￼￼￼￼￼￼￼￼￼￼￼￼abuse?). (-So if you get schizophrenia from a brain injury from a car crash, it is axis III, If you have schizophrenia coming from drug abuse, it is also axis III)

239

Trihexyphenidyl

Used for Parkinson's Disease. Anticholinergic medication. Everything almost identical to Benztropine.

240

What is the difference between analgesia and anesthesia?

Analgesia is a selective reduction of pain perception. Anesthesia is the absence of any sensation
due to suppression of CNS function.

241

What is the pathophysiology of Parkinson's Disease?

It is associated with the Nigro striatal Dopamine pathway. It is only the dopamine neurons that get damaged. It is progressive, nothing you can do to stop and halt the disease. When the dopamine neurons get damaged and we lose dopamine and D2 (which is usually inhibitory), GABA and ACh become overactive, so we try and increase dopamine or block ACh, but we would never block GABA. You can also try and activate D2 receptors to help out.

242

What is the definition of drug dependence?

Persistent use resulting in adaptations typically accompanied by accommodation or tolerance causing compensatory escalation and withdrawal (e.g. depression and cravings)

243

How would an MRI help with mental status examination?

It measures the amount of oxygen in blood in brain, BOLD - Blood Oxygen Level Dependancy.

244

What are the biological theories of mood disorders?

The catecholamine theory. Somehow this on the right (neural junction) has been disrupted at some level and they are not functioning at a smooth well coordinated way, and you end up with the bottom line below, or a combination of all of those. And the bottom line is an imbalance of dopamine, NE, or 5HT activity.

What are the two extrapyramidal side effects that drugs that target D2 and 5HT2 receptors have?

1. Tardive dyskinesias - -These tend to be D1 mediated, because dopamine isn’t acting on D2 with the D2 blockers, it is going to D1, and causing these problems, and this is a bizarre motor behavior, and this can become permanent if you leave them on these drugs for too long.
2. Parkinson's like-tremors - Same thing, because of anti-dopamine activity. And people don’t want these medications because of side effects so there is a problem with compliance, and they end up on the streets.

247

What are the two main suggestions for use of analgesics with dental pain>

1. Use prior to dental procedure, may reduce post-operative pain and inflammation
2. Start with NSAIDS- if not sufficient, start opioid drugs at low dose and go slow (prescribe only a few at a time)

248

What is the definition of drug abuse?

The use of a drug in a manner not medically or socially approved.

249

What is hyperalgesia?

It is an increased perception of pain in response to painful stimuli. On same line as allodynia.

250

What are the characteristics of Lithium Carbonate for treating Bipolar Disorder?

Slow onset, likely works by altering 2nd messenger systems such as those involving adenylyl cyclase and G proteins, often combined with anti-depressants, still among the most potent mood stabilizers, has many side effects, requires monitoring blood levels (narrow therapeutic window), tremors are common, kidney damage, weight gain, edema, high rate of compliance problems.

251

What are the characteristics of enkephalins?

Act on Delta and Mu receptors. 5 amino acids long. Made up of Methionine and Leucine.